肌少症对股骨颈骨折半髋置换术预后的影响△（开放获取）

Impact of sarcopenia on the prognosis of hip hemiarthroplasty for femoral neck fractures

摘要:

[目的] 探讨合并肌少症对股骨颈骨折半髋置换术预后的影响。[方法] 回顾性分析2021 年1 月—2023 年12 月102例因股骨颈骨折行半髋置换术患者的临床资料。按中华医学会《肌少症共识》，将患者分为肌少组与非肌少组。比较两组围术期、随访和影像资料。[结果] 本研究纳入的102 例患者中，肌少症患者38 例，占比37.3%；非肌少症患者64 例，占比62.8%。两组患者均顺利手术，均未发生围手术期死亡等严重并发症。两组手术时间、透视次数、出血量差异无统计学意义（P＞0.05），但是，肌少组在切口愈合质量[甲/乙, (34/4) vs (64/0), P=0.008]、下地行走时间[(6.7±0.7) d vs (6.0±0.5) d, P＜0.001]、住院时间[(12.4±2.2) d vs (10.9±2.0) d, P=0.001] 、切口愈合时间[(11.5±1.9) d vs (10.4±1.7) d, P=0.003] 和并发症发生情况[例(%), 6(15.8) vs 2 (3.1), P=0.021] 均显著不及非肌少组。肌少组恢复完全负重活动显著晚于非肌少组[(74.3±8.5) d vs (70.1±7.4) d, P=0.010]。随时间推移，两组内旋-外旋活动度（range of motion, ROM）、伸-屈ROM 和HHS 评分均显著增加（P＜0.05），相应时间点，肌少组均显著不及非肌少组（P＜0.05）。影像方面，末次随访时，肌少组在双侧肢体长度差（limb length discrepancy,LLD）、异位骨化、假体松动、髋臼磨损发生率均重于非肌少组，但是差异无统计学意义（P＞0.05）。[结论] 股骨颈骨折患者肌少症发生率较高，并且会影响髋关节置换术预后效果。

Abstract:

[Objective] To investigate the impact of sarcopenia on the prognosis of hemiarthroplasty for femoral neck fractures. [Methods] A retrospective analysis was performed on 102 patients who underwent hemiarthroplasty due to femoral neck fractures from January2021 to December 2023. According to the Chinese Medical Association's "Consensus on sarcopenia", the patients were divided into twogroups, the sarcopenia group and non-sarcopenia group. The documents regarding perioperative period, follow-up and images were com-pared between the two groups. [Results] Among the 102 patients included in this study, 38 were consistent with sarcopenia, accounting for37.25%, while the remaining 64 were of non-sarcopenia, accounting for 62.75%. All patients in both groups had hemiarthroplasty per-formed successful without serious complications, such as perioperative death. Although there was no significant difference in operativetime, fluoroscopy times, and blood loss between the two groups (P＞0.05), the sarcopenia group proved significantly inferior to the non-sarco-penia group in terms of incision healing quality [A/B, (34/4) vs (64/0), P=0.008], ambulation time [(6.7±0.7) days vs (6.0±0.5) days, P＜0.001], hospital stay [(12.4±2.2) days vs (10.9±2.0) days, P=0.001], incision healing time [(11.5±1.9) days vs (10.4±1.7) days, P=0.003] andtotal complication rate [cases (%), 6 (15.8) vs 2 (3.1), P=0.021]. In addition, the sarcopenia group resumed full weight-bearing activity sig-nificantly later than the non-sarcopenia group [(74.3±8.5) days vs (70.1±7.4) days, P=0.010]. The extension-flexion range of motion (ROM),interal-external rotation ROM and HHS scores significantly increased in both groups over time (P＜0.05). However, the sarcopenia groupwas significantly poorer than the non-sarcopenia group regarding abovesaid itmes at all corresponding time points (P＜0.05). As for imagingat the last follow-up, the sarcopenia group were more serious than the non-sarcopenia group in the limb length discrepancy (LLD), the oc-currence of ectopic ossification, prosthesis loosening and acetabular wear, whereas which were not statistically significant between them (P＞0.05). [Conclusion] The incidence of sarcopenia in patients with femoral neck fracture is high, and it may affect the prognosis of hemiar-throplasty.